With help from Matt DoBias, Jennifer Haberkorn, David Nather, Brett Norman and Kathryn Smith

REPEAL VOTE MAKES 33 — Lost count of how many repeal votes the House has taken? Don’t worry, House Majority Whip Kevin McCarthy has been keeping track. He says today’s full ACA repeal vote will be the House’s 33rd — including all those defunding measures the House passed in last year’s continuing resolution (it all got stripped out at the end) and all the targeted repeal bills it has passed. McCarthy’s list even counts the transportation bill, which takes out some of the “Louisiana Purchase” Medicaid money.

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VOTE CHEAT SHEET — Here are some House Democrats to watch today, based on their original votes against the ACA and how they voted on full repeal in January 2011.

PULSE insight: Boren, McIntyre, Ross and Kissell (who had already promised to vote for repeal) were the only Democrats to join Republicans yesterday to support the rule setting up debate for the House’s repeal vote. There is a chance that others will flip today, but they probably would have voted for the rule yesterday. Lipinski and Peterson told PULSE on Tuesday that they would probably oppose repeal. “I think ‘no,’ but I haven’t fully decided,” Peterson said. Lipinski said he “most likely” will vote against. “Right now, I just don’t think we can throw the whole thing out,” he said.

Happy Wednesday, and welcome to PULSE. Now that Rep. Phil Gingrey (R-Ga.) has compared the ACA to Boss Hogg, it got PULSE thinking: What if Democrats started making ACA comparisons to cast the law in a favorable light? How about a barrel of puppies? Rainbows? Santa Claus?

“Here I PULSE again on my own, going down the only road I’ve ever known”

TODAY ON POLITICO PRO:

--ROMNEY: BRING IT ON – Mitt Romney told a Colorado town hall yesterday that he can’t wait to debate Obama over health care. Good, we’re excited, too. When the clash comes, he’s ready to go with the states’ rights approach. http://politico.pro/NgIa5Q

--DEMS TIE ACA TO ROMNEY – As Democrats defend their health care law in advance of the House GOP repeal vote, they are seizing chances to tie President Barack Obama’s blueprint for reform with the 2006 law signed by then-Gov. Mitt Romney in Massachusetts. http://politico.pro/Nfva0X

--RGA HAS LOTSA QUESTIONS — Republican governors have rattled off 30 questions to President Barack Obama on ACA implementation, offering a massive to-do list for the administration before they say they can make decisions on exchanges and the Medicaid expansion. “We undertake this task with a sense of great responsibility and resolve to only move forward when we have full and complete knowledge of all the implications of our decision,” Virginia Gov. and Republican Governors Association Chairman Bob McDonnell wrote Tuesday. Of particular concern to the RGA is what happens to low-income individuals in states that don’t take the Medicaid expansion. The POLITICO Pro story: http://politico.pro/Mg09FC. The RGA letter: http://bit.ly/NeNJCo

WALL STREET BETS ON EXPANSION – Even as GOP governors posture around the Medicaid expansion, there are signs that Wall Street is expecting Medicaid to mean big business. The most obvious sign was WellPoint’s announcement Monday that it would acquire Medicaid-focused Amerigroup , and stocks for other Medicaid-heavy insurers have been doing well since the Supreme Court ruling. “The market has been looking at the Republican governors’ statements as just political,” said Richard Evans, an analyst for Connecticut-based Sector & Sovereign Research. The POLITICO story: http://politi.co/O2mJlg

SEBELIUS SAYS HHS WILL PATCH MEDICAID GAPS – Well, that was quick. In a letter to all governors yesterday, HHS Secretary Kathleen Sebelius said the administration will exercise its authority to establish a hardship exemption for certain low-income individuals in states that don’t expand Medicaid. Sebelius notes that just “a very small number” of people in those states wouldn’t already be covered by the individual mandate’s hardship exemption. Sebelius said the department is also planning to hold meetings around the country to work with states and stakeholders. Her letter, with the meeting dates: http://politico.pro/PQ5sDr

--ONLY MEDICAID EXPANSION – Her letter said the SCOTUS ruling only affects the Medicaid expansion, stressing none of the law’s other provisions were touched. There has been early chatter among some Republican governors that the court ruling could give them an out from the ACA’s maintenance of effort requirements.

FORGET ABOUT SHOW VOTES – Republican governors are about to do more to gut “Obamacare” than Speaker John Boehner could ever hope to do with today’s repeal vote. With Florida and Texas counting among the five “hell-no” states on the Medicaid expansion, about 1 in 5 of new potential Medicaid beneficiaries won’t get covered. The expansion is still in doubt in at least eight other GOP states all leaning no. The reluctance of other GOP governors to reject the expansion suggests they’re not at all sure that turning down a big infusion of Medicaid cash makes for good policy or good politics. In fact, as yesterday’s RGA letter shows, they’re trying to recast the problem as one that Obama must solve. The POLITICO story: http://politi.co/Nh9CQP

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EXCHANGE NONBELIEVERS — The Republican governors are also skeptical that federal exchanges will be ready in time for fall 2013, when they’re supposed to be fully operational. So, they’re challenging HHS to show its cards and provide a detailed work plan proving that the deadlines can be met. “If they cannot be met, the responsible course would be for HHS to level with us and the American people,” the RGA wrote in its letter.

VIRGINIA: NO NEED FOR SPECIAL SESSION — Gov. McDonnell was busy writing letters all over the place Tuesday. He also sent one to lawmakers in his home state, urging them not to bother with a special session to address ACA decisions because there are too many unanswered questions. The Richmond Times-Dispatch has more: http://bit.ly/PNI0GV

FORMER CMS CHIEFS RECOMMEND THE AGENCY ‘MAKE NICE’ WITH STATES — Three former CMS administrators who served Republican presidents have a bit of advice for Democrats trying to get Republican governors to go ahead with Medicaid expansion: Be flexible. Don’t make it a political litmus test. And try not to pour fuel on what’s already a hot-burning fire. The unexpected Medicaid ruling by the Supreme Court left the states with unexpected options and dozens of questions. The three former CMS chiefs doubt they will be answered quickly, maybe not until after the elections. While Rick Scott in Florida and Rick Perry in Texas are in open revolt against the 2014 Medicaid expansion, others are actually trying to figure out the costs and benefits, both political and economic. The three former administrators would counsel CMS to take it slow, avoid antagonizing states by issuing ultimatums and get ready for a whole new dynamic in the state-federal Medicaid negotiations — one in which the states have a lot more leverage than in the past. The POLITICO story: http://politi.co/O2mG98

OBAMA’S MEDICAID CONSOLATION PRIZE – There’s more evidence that, even when Obama loses a bit of the health care law, he might gain a bit in deficit reduction. Marilyn Werber Serafini of Kaiser Health News reports that some budget experts say the federal government could save money if states use their new, SCOTUS-blessed option not to participate in the Medicaid expansion. That’s similar to the savings the Supremes could have produced, on a larger scale, if it had knocked out Medicaid and other parts of the law, as POLITICO Pro’s Jonathan Allen reported last month. The Pro/Kaiser Health News story: http://politico.pro/Ng9krg. The Pro story on SCOTUS and the budget, ICYMI: http://politi.co/PO7xzA

--PRO-ACA SIDE HITTING REPEAL VOTE HARD – Ardent supporters of the health law will be blasting GOP members today in statements, events and press conferences in their districts, says Protect Your Care’s Eddie Vale. A sample press release starts off like this: “The Supreme Court has ruled that Obamacare is constitutional, but yet again today Republicans in Congress refused to move on and told American families to drop dead when they voted to take away their health care.”

OIG: SMELLS LIKE LOBBYING – Federal grants may have been improperly used toward lobbying, the HHS inspector general indicated in a letter circulated yesterday. The OIG report, echoing concerns raised by Hill Republicans, found that funds from the CDC’s Communities Putting Prevention to Work program may have broken the rules. “[S]ome of the CDC information, as well as the non-CDC resource materials posted to the CDC website, appear to authorize, or even encourage, grantees to use grant funds for impermissible lobbying,” the inspector general wrote. “Furthermore, grantee activity reports posted online make troubling assertions that, on their face, raise the possibility that these anti-lobbying provisions were violated.” The OIG letter: http://politico.pro/Owa23t

CHECKS, PLEASE – It doesn’t seem like there’ll be too many Hill theatrics pegged to the repeal vote, but Consumers Union will try to make things interesting. The group plans to deliver 50,000 voided MLR rebate checks to signify the $1.1 billion in insurance rebates that would be wiped away if full repeal went through. The checks: http://bit.ly/MgIow8

OBAMA PROMISES REPEAL — President Barack Obama made a reelection promise yesterday: Full repeal of the ACA, reports The Onion. In an address to the nation, Obama called the health law “a poorly conceived and irresponsible piece of legislation, pure and simple,” pledging to “strike down this unjust and unconstitutional law” as the first act of his second term. Yep, PULSE is a really big fan of America’s Finest News Source. It’s all just a joke, guys. Check out The Onion story here: http://onion.com/MWNWeP

The 2nd U.S. Circuit Court of Appeals in Manhattan rejected a 2009 city Board of Health resolution on Tuesday requiring tobacco retailers to display signs bearing graphic images showing the adverse health effects of smoking, the AP reported. http://hrld.us/MhvkjQ

The takeover of Amerigroup at the richest premium for a managed care company in 15 years is turning Medicaid insurers into the industry’s next targets, Bloomberg reports. http://bloom.bg/S1hMOo

A Pittsburgh group of hospitals is exchanging information under a health information exchange that went live last month, The Pittsburgh Post-Gazette reports. http://bit.ly/M1SZZP

The Christian Science Monitor looks in on a Massachusetts family as it considered whether to pay the state's insurance penalty or buy coverage. http://bit.ly/LedhzR

Millions of young people will qualify for good deals on health care if they take time to sort through the complicated law, the AP reports in a guide to finding health coverage for young people. http://bit.ly/S1e6w8

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Authors:

About The Author

Jason Millman is POLITICO Pro’s associate health care editor. He’s on his second tour of duty at POLITICO after a stint at the Washington Post’s Wonkblog and has covered health care since graduating from Boston University with a journalism degree in 2008.